The events of 11 September 2001 have determined many developments in world affairs and it is not surprising that their influence has reached mental health services. In the USA the trauma of 9/11 reinforced the anxieties of a nation troubled by other episodes of mass violence such as the Oklahoma bombing and Columbine massacres. The people of Britain also know what this feels like, the 7 July bombings and mass violence in Dunblane and Huntingdon are all too fresh in public minds. Therefore, this book is timely in considering our response to mass violence and disasters and how we can prepare for further episodes.
The area covered is detailed with 43 authors contributing to the chapters, mostly academics, psychiatrists and psychologists working in this field in the USA. Military psychiatry, mass violence, disasters, individual violent assault and high-risk professions are touched upon, although there is a prominence throughout of the mental health response to mass violence and in particular the 9/11 atrocities. Aspects covered include planning for disasters, preparing people who are likely to be traumatised (such as soldiers and high-risk health workers) and organisational and resource issues. This public health agenda is quite prominent, with accounts of how authorities responded to events in the USA.
The coverage of mass violence includes early intervention, intermediate and long-term treatment of victims, along with a particularly interesting chapter on improving resilience in traumatised populations. Other chapters focus on research and evaluation of services for mass trauma, training staff, consultation with communities and issues for special groups such as children and Black and minority ethnic groups.
Despite the comprehensiveness of its coverage, there were some disappointments. The focus on events in the USA (particularly 9/11) meant that the mass violence that is so prevalent in low- and middle-income countries is rarely addressed. When we reflect on events in Cambodia, Rwanda and the Congo, it seems clear that any discussion of mass violence needs to address the fact that it usually takes place in these countries where mental health resources are scarce or non-existent. However, the emphasis the authors were seeking seems to be an academic discussion of services in a high-income Western country. It is also surprising that eye movement desensitisation and reprocessing is discussed in only half a page out of over 400, despite its frequent use in the treatment of post-traumatic stress disorder (and its inclusion as a recommended treatment in the UK National Institute for Health and Clinical Excellence guidelines).
Putting aside these reservations, this is an excellent and learned resource for certain readers. Any professional involved in public mental health responses to mass violence and disasters in high-income Western countries would benefit from having a copy to read and close to hand if the worst were to happen.
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